Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial.
Håkon Ihle-Hansen, Bente Thommessen, Sara Rise Langlo et al.
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In 30 seconds
This single-blinded, multicentre randomized controlled trial examined whether age or frailty modified response to a stroke coordinator-led, individualized community intervention. At four Norwegian hospitals, 301 participants were assigned to monthly meetings for 18 months or standard care; the primary outcome was modified Rankin Scale (mRS) at 18 months. Age modified the intervention effect: among participants aged ≥ 80 years, favourable mRS outcome was less likely with intervention than control (23.4% vs 57.0%, p = 0.004). Frailty did not modify the intervention effect. The trial had found no overall functional benefit.
Key findings
- Among participants aged ≥ 80 years, favourable mRS outcome occurred in 23.4% with intervention versus 57.0% with control (p = 0.004).
- In younger participants, intervention improved Trail Making Test B by -32.2 s (95% CI -58.0 to -6.4, p = 0.015); the age-intervention interaction was significant (p = 0.019).
- No interaction between frailty and intervention was found.
Why it matters
The findings suggest that age may be relevant when evaluating responses to prolonged, individualized post-stroke support: the intervention’s effects were not uniform across age groups, and the oldest participants had less favourable mRS outcomes with intervention than with standard care. The cognitive result in younger participants also indicates that effects may differ by outcome. These subgroup findings warrant cautious interpretation alongside the absence of overall functional benefit.
What to keep in mind
The age- and frailty-related findings are subgroup analyses of a trial that found no overall functional benefit; mRS data were available for 268 of 301 randomized participants.